IntegrativeDepressionSolutions.co m NUTRTION FOR … · 2016-09-07 · An important fact here is...

NUTRTION FORDEPRESSIONHANDBOOK

Written by

Dr. Josh Friedman

Congratulations! You have made a consciousdecision to heal your depression.

I created this Nutrition For Depression Handbook to support you in making the dietary

changes that have been shown to improve mental health symptoms. Though you may

have tried many things to work with your depression, you may not have thought about

how the food choices you make affect your mental health.

We have long understood the connection between what we eat and physical illness, like

heart disease or diabetes, but are now only beginning to have an awareness of the

relationship between the kinds of food that we are eating and how we feel mentally and

emotionally. Research has show that following the diet outlined below combined with

existing therapies increases recovery rates from depression.

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IntegrativeDepressionSolutions.com

This handbook is designed to simply describe what has been found to be an optimal

mental health diet and to provide coaching tips to help you implement move towards a

diet that includes more good mood foods. These are foods that support mental health,

and foods we should be eating every day. The handbook also provides information about

Bad Mood Foods, or foods that can contribute to depression symptoms and should be

avoided as much as possible.

An important fact here is that these are just guidelines. This is what works for the

average person, but you are not average. You are YOU. As you work with food and pay

attention to your body, you will learn what works for you and what doesn’t. These

recommendations are a starting point, a place to enter a process of self-discovery.

The last point I want to make is to encourage you to be disciplined but patient and kind

with yourself. Small changes, like an effort to avoid boxed and processed foods,

avoiding sugar or cooking for yourself more, can lead big changes in how you feel.

Remember that change is a step-by-step process that involves putting small steps

together. Usually it means making a small changes and getting used to it before moving

onto the next goal.

Finally I would like to acknowledge the teachers whose ideas have been informed my

thinking. Books focusing on Nutritional Mental Health that provide the sourcing of much

of the information in the handbook include: The Mood Cure by Julia Ross, MA,

UltraMind Solution by Mark Hyman, MD, Potatoes Not Prozac by Kathleen Desmaisons,

PhD, The Anti-Anxiety Food Solution by Trudy Scott, CN, and A Mind of Your Own by

Kelly Brogan, MD

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General Guidelines- What To Eat Every Day:Protein 75 grams

Non-Starchy Vegetables 4 servingsFruit 2-4 servings

Legumes ½ cup a few times a week (1 cup if

vegetarian)Starchy Vegetables 1 servingGluten-Free Grains 1 cup

Fats ¼ cup of oil/ghee, ¼ cup of nuts and

seedsLiquids 50 oz. or more of water, herb tea or

veggie juice

Some recent research has supported the use of a more traditional or “Paleo” diet. This

diet focuses on consuming foods that were available to before the farming began. It‘s

guidelines would be similar the diet above but would additionally restrict ALL grains and

legumes because in many people with chronic illnesses, these foods can be

inflammatory and can make depression worse. If you are depressed and know you have

an autoimmune condition, significant GI issues (IBS, Crohn’s, Colitis, or Celiac etc.),

systemic inflammation or if you implement the diet above for at least a month and

noticed little or no changes in your depressive symptoms, I would recommend starting

with a more restrictive Paleo diet. Go to Whole30.com for more information on a simple

and easy to implement version.

1. Protein: 75 grams of protein throughout the day (25 grams 3x a day,

or a bit less if you’re having snacks with protein between meals)- find a

protein calculator on-line to know calculate protein grams in common

foods.

Meat- 1 serving= 3 or 4oz.=palm of your hand= about 25g

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If you are a meat eater, eat quality animal proteinsuch as grass-fed beef, wild game, pastured poultry, eggs from pastured hens and wild

fish (non-farm raised). Grass fed beef and pastured poultry (and eggs) are high in

Omega-3 oils, containing the best composition of fats for optimal brain function.

Vegetarian/Vegan options:

Legumes: (mung beans, split mung, lentils (red, green, brown), adzuki, black

beans, black eyed peas, garbanzo beans, hummus, lentils, pinto beans, split peas and

others- beans combined with rice is a complete protein (has all of the amino acids

necessary for life and is a staple in many cultures).

Other options: rice protein powder, nuts and nut butters, seeds. Grains have

some protein (quinoa is the only grain that is a complete protein.) As plant based

sources of protein are not complete proteins, food combining is essential (for instance,

neither rice and beans are complete proteins, but combined, provide all the amino

acids). Though slightly more difficult than eating meat, it is completely possible to meet

you need for protein without consuming animal products. It just takes more effort and

consciousness.

The Greek translation for protein is “Of primary importance” This is so true from a mental

health perspective. Without protein, neurotransmitters cannot be made to provide

positive and stable moods. The most important dietary change anyone could make to

improve depression has to be getting enough protein! I commonly see people who begin

to increase their protein intake to 75mg a day, see their depression become a thing of

the past. Often people are not aware that they are protein malnourished which can have

significant negative mental health consequences.

2. Non-Starchy Fresh Vegetables4


4 servings or more per day1 serving= 1 cup cooked veggies or

2 cups raw green leafy veggies and salads

Artichokes, asparagus, avocados, bell peppers, bok choy, burdock, carrots, celery,

Cilantro, cruciferous vegetables (such as broccoli, Brussels sprouts, cabbage, and

cauliflower), cucumber, daikon, eggplant, fennel, garlic, ginger, green beans, green leafy

vegetables and salad greens (such as arugula, beet greens, chard, collard greens, kale,

lettuce, mixed baby greens, mustard greens, nettles, and spinach), mushroom, onions,

parsley, radishes, sweet peas, summer squash, tomatoes, turnips and water chestnuts.

3. Good Fats: ¼ cup of good fats and about ¼ cup of nuts and seeds a

day

Eat some form of good fat with each meal and snack. Cook with Ghee (clarified butter

which can be found at health food stores or is quite easy to make, can usually be

tolerated by those sensitive to dairy), non-hydrogenated coconut oil, and palm kernel oil

for high heat. Olive oil for moderate heat cooking and for salads (buy olive oil that is

“cold pressed” and organic and sold in dark bottles).

Other good fats include: coconut milk (think Thai cooking), avocados, flaxseeds, other

raw seeds (sunflower seeds, sesame seeds, and pumpkin seeds), raw nuts and nut

butters (raw almonds, brazil nuts, cashews and walnuts), and pemmican (healthy beef

jerky)

4. Fruit

2-4 serving (less for higher sugar tropical fruit)1 serving= 1 medium banana, 1 small apple or ½ cup of berries (if Candida is

an issue elimination of fruit may be necessary for awhile)

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Apples, apricots, bananas, blackberries, blueberries, cantalouple, cherries, cranberries,

figs, grapefruit, grapes, honeydew, kiwi, lemons, mangoes, melons, nectarines, oranges,

papaya, peaches, pears, pineapples, plums, raspberries, strawberries, tangerines, and

watermelon

5. Legumes: If you are eating meat as part of the plan, at least ½ cup to 1 cup,

a few times week (if vegetarian, 1or more cups a day)

Black beans, black-eyed peas, garbanzo beans, lentils, mung beans, pinto beans, split

peas and others

6. Starchy Fresh Vegetables: At least 1 serving a day (unless

you do not tolerate them)

Beets, corn, peas, potatoes, sweet potatoes, turnips, and winter squash (such as

butternut and pumpkin)

7. Gluten-Free Whole Grains: 1 cup of cooked grains a day

Amaranth, brown rice (and other whole grain rice), buckwheat, corn, millet, quinoa, wild

rice, gluten-free oats (Bob’s Red Mill brand has a gluten-free version)

Foods to avoid

1. Processed Foods: Boxed and packaged foods

typically contain additives, preservatives, artificial colors, and

flavoring agents such as MSG (other names for MSG are:

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hydrolyzed protein, autolyzed yeast, and sodium caseinate—

MSG is a know neurotoxin that can worsen mental health

symptoms. Commonly found in canned and instant soups,

cheese spreads, breakfast cereals and frozen dinners.) Also

steer clear of energy bars with lots of sugar and concentrated

soy protein. There are some better and healthier prepared

foods that you can find at stores like Trader Joes or Whole

Foods but you are usually better eating real whole foods

made at home.

2. Trans Fats: Trans fats are not recognized by the body and are therefore

experienced as toxic. They are common in margarine, processed foods and baked

goods. Stay clear of all vegetable oils (such as canola, corn, and soy) as they are

dangerous to the body. Avoid products that contain the following ingredients: “partially-

hydrogenated vegetable oil”, “hydrogenated vegetable oil”, “shortening” as these contain

dangerous trans-fats.

3. Sugar, Artificial Sweeteners, and Soda: Avoid all forms of

added and hidden sugar. Read labels carefully. The worst offender health-wise is high-

fructose corn syrup. Just avoiding high-fructose corn syrup will provide significant health

benefits. Hidden sugar also includes corn syrup, glucose, maltose, sucrose etc. Artificial

sweeteners should also be avoided and include aspartame, saccharin, and sucralose.

4. Gluten and Dairy: These are the two most common foods in the

Standard American Diet that cause delayed food sensitivities. These sensitivities

can lead to mental health and physical symptoms. The most definitive way to test

for sensitivity is to remove all gluten or dairy (one at a time) for two weeks and

then reintroduce and notice the changes that occur from getting off and then

reintroducing. An accurate way of testing for delayed food sensitivities is called

IgG Food Allergy Testing available through a number of labs that focus on

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Functional Medicine Testing including Genova Diagnostics and Great Plains

Laboratory (most conventional MDs, even allergists, are unaware of the

usefulness of IgG testing but more and more Functional Medicine, Naturopathic

and Integrative practitioners use this test with great success.)

5. Genetically Modified Food (GMOs): The research

is piling up on the dangers of GMOs. As of 2016, 38 countries have already

banned GMOs, not including the US, where most of the nonorganic corn, soy

and canola is Genetically modified. As foods in the US do not need to be

labeled if they are GM, the only way to assure that food is not GM is to buy

organic.

6. Caffeine: Avoid coffee (even decaffeinated), tea (except herbal,

caffeine free, and green tea) and foods and beverages that contain caffeine.

These foods squash healthy appetite, stress the adrenal glands which

produce the primary stress coping chemical produced by the body (cortisol)

and makes blood sugar instability worse.

The Good Mood Meal

Now that you know what to eat throughout the day, the next step is to begin to zero in on

what each meal should look like. The more clarity you have, the more likely you will be to

work with changing your diet in positive ways.

For balanced meals follow the following general guidelines:

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1. Start by looking at the palm of your hand. The palm represents the protein portion of the

meal (about a quarter of the plate).

2. Next comes the low carbohydrate vegetable portion of your plate, which will take up a

little over half of the plate.

3. The corner of your plate is reserved for high carbohydrate veggies, grains, or fruit (if

your body can tolerate these foods). High carbohydrate veggies include things like

potatoes, squash and yams. This is going to be about 15-20% of your plate.

4. A small percentage of your plate will be for oils or fats used to prepare or season food,

for instance a pat of butter on your potato, or a few tablespoons of olive oil to sauté

vegetables in or on a salad; this is in addition to the fat in your fish, chicken or other

foods, such as nuts or avocados.

There are a number significant differences between the Standard American Diet and the

Good Mood Meal. First, the Good Mood Meal has way more veggies. Low

carbohydrate vegetables are no longer a side dish but are much of what we consume.

Second, the ratio of low carbohydrate veggies to high carbohydrate veggies, grains and

fruit is altered, so the Good Mood Meal contains 3 servings of low carbohydrate veggies

for every serving of grain, fruit, or high carbohydrate veggies. This increase of low carb

veggies helps to bring down the glycemic load (this is how much a given food raises

blood sugar and can lead to blood sugar instability. Low and unstable blood sugar is one

of the main dietary causes of depression, anxiety and other mood issues.) Third, the

amount protein may be smaller than typical American meal but is included in every meal,

as is fat. As protein is the only macronutrient that cannot be stored by the body for later

use, our mood stability requires frequent and consistent ingestion of protein. Fourth, the

Good Mood Meal is also gluten and dairy free, and sometimes grain and legume free,

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without caffeine or added sugar. The focus is on real foods and foods that are likely to

promote mental health.

Meat Eaters Example: Chicken breast, potatoes, and a salad. Make the

chicken breast the size of your palm, about ¼ your plate. Instead of the typical American

side salad, have a big salad (3-4 times the size of the meat-make the salad chock full of

colored vegetables, like carrots, cabbage and red peppers, “eat the rainbow”. If instead

of salad, you were having cooked veggies, you would make them twice the size of the

piece of meat. Have a medium sized potato. For fat, have some olive oil or ghee on the

potato and some dressing on the salad.

Vegetarian example: Vegetarian chili (loaded with vegetables and about a

cup of black beans per serving.), 6 spears of asparagus drizzled in olive oil, and a ½ cup

of quinoa with chopped almonds and raisins. Because food groups are often mixed in

vegetarian cooking, ratios of food groups are more difficult to determine. In terms of the

low carbohydrate vegetables, about half comes from the chili and half from the

asparagus (6 spears of asparagus= ½ cup of veggies). The cup of beans and the nuts in

the quinoa make up the protein part of the meal. The ½ cup of quinoa account for the

High carbohydrate grain and the olive oil on the asparagus and oil used to sauté the

veggies for the chili account for the fat. One note, because many the protein sources in

the vegetarian diet are also contain carbohydrates, vegetarian diets are often higher in

carbohydrates. Don’t worry. Just shoot to increase low carbohydrate vegetables while

making sure that you get enough protein.

Meal Planning

Now that you have an idea of the proportions of your plate and what to include and not

include. What are we going to eat? The options are really endless. I will give you some

examples of balanced meals that you can try. There are many whole foods, gluten free

(and dairy free), or paleo recipes readily available on the web.

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More than anything keep it simple! Preparing nutritious and tasty food does not have to

be complicated. Slate an hour during the weekend to think about what you are going to

make for the coming week (if you can plan a 7 day list of what you will make for

breakfast, lunch and dinner, this will likely help as you are beginning to make the

changes outlined in the handbook). As you are thinking about meals for the week, make

a shopping list of the things you will need from the market. This way you will have what

you need when you come home tired from work. This thinking ahead really makes a

difference here.

Remember cooking gets easier with practice. A teacher of mine once said “To learn to

cook you have to be willing to burn the rice”. Practice, practice, practice. For most,

starting with simple recipes is the way to go, while for other going the intuitive route

seems best.

Breakfast

If you want to control craving and stabilize mood, breakfast is the most important meal.

Grabbing a muffin and coffee or a bagel makes us vulnerable to blood sugar instability

along with depression, anxiety and cravings for sweets a few hours later. The challenge

with breakfast in America is to eat something that is balanced with enough protein and

fat and not too much processed carbohydrates. Pancakes, waffles and donuts are a

mood disaster.

Good Mood Breakfast Ideas

1. Smoothies- delicious and nutritious meal in a glass, which can be a great balanced

protein-carbohydrate-fat drink. See recipe included in this packet

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2. Cream of rice or soft hot polenta with a dash of cinnamon or nutmeg plus one or more of

these sources of protein (rice protein powder, seeds or nut milk, or raw nuts and seeds).

Quinoa hot cereal is a great option because it higher in protein than most grain based

cereals.

3. Scrambled eggs with veggies. You can sauté 3-4 cups of veggies in pan in broth, a little

water, butter or olive oil (they will cook down in size). After they are done, scramble in

the 3 eggs. Serve with nitrate-free bacon or sausage or organic turkey bacon. Can also

have polenta with a bit of tomato sauce as a side:

(a). You can also include the same ingredients in a frittata. If you’re in a rush, a few hard-

boiled eggs will be better than coffee and a donut. The idea is to move things in a

balanced whole foods direction.

4. Gluten-Free oatmeal (Bob’s Red Mill has a certified organic gluten free variety) with

some fresh fruit on top and almond butter and almond milk mixed in.

5. Think dinner or lunch for breakfast—left over stew or soup with some sautéed greens.

Any dinner food can work for breakfast even if other people with think it’s weird

Good Mood Lunch Ideas

1. Leftovers: from dinner the night before. Cook enough dinner to be able to

bring it for lunch. Joshua Rosenthal, nutrition educator, says “cook once, eat

twice.” Best if heated at home and stored in an insulated container so that you do

not have to use a microwave it, but it’s OK if you have to as well. Just make sure

the meal is balanced.

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2. A big salad: Start with one or more kind of lettuce (try to avoid iceberg

lettuce and it deficient in vitamin and minerals found in more “green” lettuces, like

red leaf, romaine or arugula); Add 1 cup or more of low carbohydrate veggies, ½

cup of beans, corn, or high carb veggies, and ¾-1 cup of sliced meat (stay away

from “luncheon meats” which usually have nitrates and other harmful substances

in them, organic sliced meats found at Whole Foods and Trader Joes is OK), or

raw nuts/seeds, or cheese (if dairy works for you). Dress with 2 tablespoons of

salad dressing without sugar (one idea is to make a dressing at home with 3

parts olive oil, 1 part Bragg’s Organic Apple Cider Vinegar (a time honored

remedy which has a variety of vitamins and minerals. It helps with digestive

health and helps to stabilize blood sugar levels) with added spices and mustard.

3. Soup or Stews: Heat at home and bring in a thermos. Can be veggie,

beans or meat. Ideas include Split pea, lentil, black bean, or chicken or turkey

soup etc. Challenge yourself to find a recipe that you love. Make it a few times

until you’ve got it down and then try another one. Before you know it, you will

have a variety of soups that you look forward to preparing and eating. When

thinking about soups make sure that you are getting enough protein per serving.

If not, you can supplement with some easy protein. Chicken breast, a piece of

salmon, nuts or seeds.

4. Sandwiches: Just avoid gluten-containing grains. Visit the gluten free

section of any grocery store and see the variety of options including rice bread

and Potato bread. They don’t always hold up as well as wheat or rye breads but

they are surprisingly good (if you are preparing a sandwich at home try open

faced and toasted). Make it a tuna, chicken or turkey sandwich (can be from last

nights dinner) or from hormone and nitrate free deli meat. Load the sandwich

with veggies like tomatoes, carrots, celery, peppers, and avocado).

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5. Non-gluten pasta: (rice or quinoa etc.) are good options. Can be

prepared with red sauce, loaded with veggies, and some sort of protein. Shrimp

or chicken or tofu would be good options or make it a meat sauce with grass fed

ground beef or organic ground turkey. You could also use beans in this dish.

Instead of pasta you could use polenta here.

Good Mood Dinners

Dinner is often the biggest meal of the day in America. Many traditions have their biggest

meal at lunch, which provides more time for digestion. You might want to try a bigger

lunch and smaller dinner as an experiment. This said, dinner is the meal that most of us

take time to prepare, compared to breakfast and lunch which we are more likely to eat

on the run. Planning and thinking ahead can often make the difference whether our

dinner is a balanced mind meal or whether we throw something frozen in the microwave.

You can do thins by knowing what simple dish you will be making before you get home,

maybe even having made part of it in previous days. For instance maybe you have a

sweet potato that is already baked or veggies that are cut up and ready for a stir-fry or

salad.

If you are a meat eater it is good to get used to easy ways prepare beef, fish and

chicken as they are often an important part of dinner:

Fish

Hearty fish that are relatively easy to cook include: wild salmon, tuna, sea bass, halibut,

red snapper, mahi-mahi swordfish, blue marlin or any white fish like flounder or haddock

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(sole and trout are more delicate and cook much faster.) The simplest preparations

include pan searing and baking in the oven (simple directions can be found on the

internet).

Chicken

Can be prepared many ways. It can be roasted in the oven as a whole bird or breast

(can feed a whole family or have leftovers for lunch the next day), boneless breasts can

be pan fried with or without gluten free bread crumbs or even boiled in soup and of

course on the grill if you have one. Turkey can also be prepared in similar ways.

Beef, Pork Can be roasted, grilled, or pan-fried depending on the cut.

With all meat it is important to buy antibiotic and hormone free. For chicken, by pastured

chicken and for beef buy grass- fed. It makes a huge difference in quality.

Vegetables

Vegetables are the food group most sorely missing from the Standard American Diet.

Our mothers were right, we need to eat our veggies. They provide the vitamin and

mineral cofactors necessary for every metabolic process in the body including making

the mood stabilizing hormones and neurotransmitters. So, low veggie consumption can

lead actually lead to bad moods!

An easy way to prepare many veggies is to take a pan with 1/8 inch of water, crumple up

½ a veggie or meat bullion cube in it and put the veggies you want to cook in it. Heat

uncovered. When the water evaporates take the veggies for doneness. If it needs more

cooking add a little more water. When veggies are done put some butter in the pan to

melt and cover the veggies or drizzle with olive oil. Steaming, boiling, sautéing and other

methods you will discover along this path also work well. Don’t forget roasting. There is

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nothing better than a winter roast of root veggies. After a plate of sweet roasted

vegetables you won’t miss the artificial sweetness of candy.

Topping for Vegetables

If you aren’t used to eating a lot of veggies here are some ideas to top your veggies from

Julia Ross, mental health nutrition guru:

- Tomato sauce with sheep or goat feta cheese and/or pumpkin seeds and/or

crumpled tofu. Good with steamed zucchini or other squash

- Olive oil (great on everything)

- Ghee and lemon juice (great with broccoli and asparagus)

- Fresh herbs (try dill with carrots and mint with peas)

- Garlic. Spinach and other greens are great sautéed in oil with minced garlic

(start sautéing the garlic first then add greens).

-Almond, cashew or sesame butter (make it a sauce by blending it with a little

water (great on green beans)

-Mustard or horseradish sauce (mix powdered mustard or horseradish with a

little water and oil (nice with asparagus or broccoli especially when

served with beef.

-Greek yogurt with fresh herbs, salt pepper and garlic. Good with green

beans, broccoli pieces and onions.

-Avocado dressing. Make in a bowl by mashing an avocado with a fork. Add

2 Tbs. olive oil, a little garlic salt, pepper, cilantro or parsley and lemon

juice to taste. A thinner dressing can be make by adding more yogurt

and/or using a blender

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-Brags Liquid Aminos (healthy alternative to soy sauce, that is low sodium,

gluten free), and pepper

-Brags liquid Aminos and lemon juice

-Homemade oil and vinegar (can use balsamic or raw apple cider). Mix it up

with different spices and Dijon mustard.

A few Good Mood Dinner Ideas

1. Meatloaf with gluten free bread crumbs, a large salad with a variety of veggies,

and a medium sweet potato with butter

2. Chicken stir-fry with loads of different veggies (the more the merrier) atop

basmati rice or rice noodles. You can serve it with a bowl of miso soup with tofu

and spinach.

3. Large bowl of Indian spiced Dahl over basmati rice. Plate of greens like rainbow

chard sautéed in butter with added crushed tomatoes. End the meal with a baked

apple with nuts and raisins.

4. Meal in a bowl- big bowl of Thai coconut milk rice noodle veggie soup with either

tofu or chicken.

Steps in the Process

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For many people eating the standard American Diet (SAD), transitioning to a diet that

supports mental health can be daunting. Where to start? The basic steps below might

help you organize your experience. Try to master each step before going onto the next

one.

1 Start by eating a breakfast every day that contains at least 25g of protein (protein

counters are easy to find on the web).

2. Begin to have 3 meals a day with at least 25g of protein.

3. Focus on adding a serving or 2 of low carbohydrate veggies to each meal.

4. Remove all gluten containing grains from your diet. Experiment with non-gluten

containing grains as additional sources of carbohydrates in the proportions laid out in

this handbook.

5. Work to remove all sugar, artificial sweeteners, caffeine and alcohol from your diet.

Closing Thoughts

As Hippocrates said: “Let Food be your medicine and your

medicine be your food”. This handbook was developed to help inspire you to take

your depression healing into your own hands. Though doctors may be helpful in many

ways, they do not have all of the answers. They do not live in your body. Only you have

a direct experience of how your body responds to different foods.

Could it be possible that some simple but consistent dietary changes could quell your

anxiety or depression? I think that many feel so. Take 25 year old Janie whose

depression lifted after getting off of gluten containing grains, or 36 year old Louis who’s

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anxious depression leveled after eating more regularly and stabilizing his blood sugar by

staying away from sugar laden sweets and soda

The only way to know is to know for yourself. Make a conscious choice to make

changes and observe and then to make more changes and observe again. Do so with

consistency, compassion and patience.

And now we begin…

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